MPs warn of NHS care "breakdown"

Care provided by the NHS health and social care system will break down if quicker progress is not made to develop more integrated services which focus on meeting the needs of individual patients, MPs have warned.

With public expenditure on health and social care services until 2014-15 and beyond likely to show little if any increase from 2010-11's levels, the only way to sustain or improve present service levels in the NHS will be to focus on a transformation of care through genuine and sustained service integration, says the House of Commons Health Select Committee, in a new report.

"Services should be designed to treat people rather than conditions. They need to respond to individuals rather than expecting individuals to find their way round a bewildering range of specialist departments," said the Health Committee's chair, Stephen Dorrell MP.

"To make this ambition a reality, we need to develop a much more joined-up approach to commissioning health and care services - we propose that responsibility for this process in a given area should be vested in the Health and Wellbeing Board [HWB]," he went on.

"Joined-up commissioning would ensure that resources are no longer treated as 'belonging' to a particular part of the system, but become shared resources to use more efficiently to develop and deliver more flexible and responsive local health and care services."

However, the MPs emphasise that moving to this approach must not result in less overall funding for care services. "We therefore propose that the government's commitment to protect real-terms funding for health care should be extended to cover local authority social care services and that these funds should be ring-fenced at current levels in real terms," says Mr Dorrell, who is Conservative MP for Charnwood.

The MPs' report is also critical of the measures currently being used to respond to the "Nicholson Challenge" - the commitment set by NHS chief executive Sir David Nicholson for the Service to achieve £15-££20 billion-worth of efficiency savings from 2011 to 2015. Too often, these measures represent short-term fixes rather than sustainable long-term service transformations, they say.

And they go on to warn that the NHS will not be able to rely on the present rate of pay bill savings once the present restraints on public-sector pay are relaxed in April. While they acknowledge that pay restraint has the short-term effect of reducing the cost of service provision, this cannot be regarded as a sustainable form of "efficacy gain," they say.

"It is neither prudent or just to plan for sustainable efficiency on the basis that NHS pay will continue to fall relative to pay elsewhere in the economy. Sustainable efficiency gain involves securing improved quality of value for a given expenditure - it is not delivered by simply suppressing staff salaries alone."

Still less is efficiency gain secured by reducing the tariff paid by an NHS commissioner to an NHS provider. Tariff payments within the NHS are simply internal transfers that only result in efficiency gain for the NHS if the service provider changes the way care is delivered, the MPs point out, but express their concern that "both NHS management and Ministers appear to be convinced that charging an internal transfer payment constitutes a form of efficiency gain."

The report also notes the adverse comment attracted by underspending against budget allocated to the NHS, and call for a general review of the operation of Treasury rules. In particular, they say, the rules on use of reserves by NHS providers should be abolished to encourage investment by providers in necessary service change.

Commenting on the MPs’ findings, NHS Confederation chief executive Mike Farrar said they raise "some critical questions about how we secure the future of the NHS."

"The NHS has reached the point where its financial predicament is on a scale we have never seen before, and we no longer have the luxury of time or extra money on our side," he said.

Mr Farrar stressed the need to look beyond the short-term options and consider more radical solutions, and the importance of involving the public in these discussions.

"We can do much more to create a modern, affordable system that works in the best interests of patients. Getting this right may require some difficult decisions, including centralising some services and moving others out of hospitals and into people's homes. To make this work, we will need strong political will and public support, putting forward robust, evidence-based clinical and financial cases for change," he said.